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Gronewold N, Mayer G, Müller Y, Levinson RT, Bruns B, Meyer AL, Rivinius R, Frey N, Kreusser MM, Schultz JH. Recognition of psychological comorbidity and psychotherapeutic treatment status of ventricular assist device patients. Artif Organs 2024. [PMID: 38984611 DOI: 10.1111/aor.14825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/17/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Due to its high impact on quality of life and mental health, close monitoring and often psychotherapy is recommended for patients with a ventricular assist device (VAD). This study investigates the psychological comorbidity and the corresponding psychotherapeutic treatment situation of VAD patients. Special attention is also given to the professional perspective VAD team (assistant and senior cardiologists and specialized nurses). METHODS We conducted a cross-sectional observational study. Data from 50 VAD patients (mean age = 53.52, standard deviation = 13.82 years, 84.0% male) and their VAD team were analyzed. The presence of a psychological disorder was evaluated by structured clinical interviews for DSM-IV (SCID-I-Interviews). Patients answered a questionnaire regarding their current psychotherapeutic treatment status and their attitude towards psychotherapy. The VAD team answered a questionnaire about the patients' needs for psychotherapy and indicated whether they addressed this topic with the patient. Data were analyzed descriptively, by analysis of variance and t-test. RESULTS A total of 58% of VAD patients suffered from at least one significant psychological disorder, 79.3% of those were not in psychotherapy. The VAD team could not identify the patients who suffered from a psychological disorder (F = 1.90; p = 0.18). They perceived more need for psychotherapy than they addressed with their patients (T = 3.39; p < 0.001). CONCLUSIONS While there is a high psychological morbidity among VAD patients, only few receive psychotherapy. Psychological comorbidity is not easily detected by the VAD team. Standardized psychosocial care could be implemented by regular psychological assessments and further information of patients and their VAD teams.
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Affiliation(s)
- Nadine Gronewold
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Gwendolyn Mayer
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Yvonne Müller
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rebecca T Levinson
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Bastian Bruns
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
- Institute of Experimental Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Anna L Meyer
- Department of Cardiac Surgery, University of Heidelberg, Heidelberg, Germany
| | - Rasmus Rivinius
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Jobst-Hendrik Schultz
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
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Morbach C, Wagner M, Güntner S, Malsch C, Oezkur M, Wood D, Kotseva K, Leyh R, Ertl G, Karmann W, Heuschmann PU, Störk S. Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort. BMC Cardiovasc Disord 2017; 17:108. [PMID: 28476146 PMCID: PMC5420109 DOI: 10.1186/s12872-017-0543-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/28/2017] [Indexed: 01/10/2023] Open
Abstract
Background Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. Methods Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. Results 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. Conclusions In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. Trial registration This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Güntner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Carolin Malsch
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Public Health, University of Ghent, Ghent, Belgium
| | - Rainer Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany. .,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany.
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